The small and almost unknown town of Austin, Indiana – population 4,200 – is the center of the worst surge in cases of HIV and Hepatitis C in state history. And the epidemic is stemming entirely from one drug – Opana ER extended release oxymorphone – being injected with shared needles.
Although Opana ER is made in an “abuse deterrent” form, users easily have discovered how to get around that mechanism, said Dr. Jerome Adams, Indiana’s State Health Commissioner. “It’s important that we all understand that just because a drug comes in an abuse deterrent form, that doesn’t automatically make it safe.”
By April of this year, the number of confirmed cases of HIV in southeastern Indiana had climbed to 136 just since November 2014. And this is in a region that historically has seen less than 5 cases a year. Meanwhile, there were six additional preliminary cases, said CDC officials, awaiting confirmation. If positive it would bring the total to 141.
Added to the HIV, co-infection with the Hepatitis C virus (HCV) also has been diagnosed in nearly 85 percent of patients.
The number of HIV cases rang alarm bells all the way from rural Indiana to the CDC. The state’s chief medical consultant told a CDC briefing that roughly four out of five infected patients reported injection drug use, while some of the others reported partners as injection drug users.
In Scott County, where most of the current infections are, fewer than five cases of HIV per year have been reported in the past. “This is the first outbreak of its type that we have seen documented in recent years,” said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS in Atlanta.
Opana ER and shared syringes – a deadly combination
The majority of cases have been linked to dissolving tablets of the prescription opioid oxymorphone (Opana ER or Extended Release) and injecting it using shared syringes.
“We have not seen an outbreak of HIV specifically associated with the injection of oral opiates previously,” Mermin said. And the Indiana State Department of Health said that the injection drug use is “a group activity in this population” – with as many as three generations of a family, along with multiple community members, all injecting together and sharing needles.
Patients have ranged in age from 18 to 57 years and are on average 35 years old. A total of nearly 55 percent are male.
Opana (oxymorphone) has a half-life of approximately 4 hours. That means dependent users begin to feel withdrawal symptoms around that time. “We have heard that folks are injecting from 4 to over 10 times a day,” one official said.
Once crushed, the Opana pills are less “dissolvable” than, for example, heroin. The anti-abuse formula renders it thick and lumpy, requiring a thicker gauge needle to inject. “That is making the sharing of needles an even higher risk activity,” said Health Commissioner Adams, “because you’re being inoculated with higher amounts of HIV virus.”
Needle exchange programs are currently illegal in Indiana, so the only recourse for addicts is to buy or steal new needles, or share used needles. In late March, Indiana Governor Mike Pence (R) signed an executive order authorizing a 30-day needle exchange program, and then was persuaded to extend the program for another 30 days. But needle exchange alone “is minimally effective,” said Adams, “so it must be part of a comprehensive response.”
Indiana has a prescription drug monitoring program that lets health officials give physicians feedback about their prescribing habits, Adams said. The state also is taking “a four-pronged approach to the outbreak” that includes the development of a ‘one-stop shop’ that provides testing, treatment, and follow-up; a needle-exchange program now being offered by the Scott County Health Department; a public awareness campaign and additional HIV testing and treatment at a local health clinic.
“This outbreak that we’re seeing in Indiana is really the tip of an iceberg of a drug abuse problem that we see in the U.S. that is putting people at very high risk for infectious diseases,” Adams said.
And the CDC has released a health advisory to alert healthcare providers and health departments of the HIV outbreak and HCV co-infection. The advisory details how to identify and prevent the spread of HIV and HCV and urges providers to refer patients with substance abuse problems for medication-assisted treatment and counseling.
The principal adverse effects of Opana (oxymorphone) are similar to other opioids. The most common are constipation, nausea, vomiting, dizziness, dry mouth and drowsiness. Of course, it’s highly addictive and can lead to dependence, withdrawal symptoms or overdose.
Here at Novus, we routinely achieve great success treating dependencies to prescription opioids such as Opana ER. If you or a loved one needs help with an opiate dependence, don’t hesitate to call Novus. We’re always here to help.
Neuroscientists at Washington University School of Medicine in St. Louis have found a way to activate the brain’s pain-relieving mechanism using nothing but light.
Although the research is in the very, very early stages, the scientists say that some day in the future, doctors might be able to treat pain with safe, non-addicting doses of light, instead of the dangerous and addictive opioids in such wide use today.
To understand how the light idea works, we first need to know that all those opioid pills and injections we call “painkillers” are in fact not painkillers at all. They simply flip some switches in our brains and body that activate the body’s own natural pain-relieving system.
The second thing, and really the only other thing we need to know, is this really big news:
According to the research, the body’s pain-relief switches can be flipped on using something other than opioids – in this case, simple light.
How opioids work
When we take opioids, they interact with special receptors in our brains and body called “opioid receptors.” In simple terms, this causes the receptors to initiate biochemical activity in specific chemical pathways, reducing our sensitivity to pain.
So painkilling ability is not contained in the opioid painkillers – our own bodies have that ability. Opioids are just the activators – they flip the switches that turn on the body’s own painkiller system.
We’ve called these switches “opioid receptors” because opioids have been the only substances known that so quickly and thoroughly switch on the body’s built-in painkilling system.
The question has been: What if some other substance, a non-opioid with no side effects, could be found that will flip these switches – something that is neither dangerous nor habit-forming?
That’s what the researchers at Washington University were trying to find out. And they say they’ve found a very exciting possibility.
The search for alternatives to opioids
Searching for some other non-opioid substance that might activate the opioid receptors could take, literally, forever. You might never find anything that works. Furthermore, no one is exactly sure how these receptors even work – not in complete detail, anyway. They’re complex, and in fact do a lot more than just regulate pain.
Instead, the scientists decided to try altering the receptors themselves. Perhaps they could make the receptors sensitive to some known substance – one they could select in advance. If it worked, perhaps it could lead to better pain-killing drugs – ones with fewer side effects.
They decided to test the theory using a light-sensing protein called rhodopsin, which senses light in the eye’s retina. If they could somehow combine rhodopsin with opioid receptors, maybe the receptors would “switch on” with light instead of needing opioids.
In the lab, the scientists were able to merge light-sensing rhodopsin into key parts of opioid receptors, creating new receptors that respond to light in exactly the same way that standard opioid receptors respond to opioids.
They injected these altered receptors into the brains of lab mice, and the results were astonishing. When the researchers shone light on the receptors that contained rhodopsin, the same cellular pathways were seen to become activated. The mice reacted to light in the same way that normal mice – and people for that matter – react to opioids.
The researchers were able to vary the animals’ response depending on the amount and type of light. Different colors, longer and shorter exposures and pulsed or steady light all produced slightly different effects.
Will light or other substances just act the same as opioids?
Opioids can create tolerance, dependence and addiction. They can interrupt normal breathing and function of the central nervous system, called overdose. There are many other side effects.
Will receptors altered to respond to light act the same as the standard ones do with opioids?
The researchers wrote that, in theory at least, receptors tuned to light may not present the same dangers. In fact, they say that someday it may be possible to activate, or deactivate, painkilling nerve cells without affecting any of the other receptors that today’s opioid painkillers trigger – the ones that potentially lead to tolerance, dependence and overdose.
And if pain patients have to have altered light-sensitive receptors injected into their bodies, how will you ever turn them off when the painful condition is healed? Or will people have to spend the rest of their lives avoiding light?
Many unknowns remain, and the questions are fascinating. Hopefully more research will tell us in more detail what the future might hold. The goal is pain control without side effects or dangers. Perhaps science can answer this need and bring an end to the scourge of opioid addiction and accidental death.
Meanwhile, here at Novus, we’re busy dealing with the real world of today – the seemingly endless problems of opioid painkiller use and abuse. And the message is this: Don’t hesitate to pick up that phone and call us if you or someone you care about is troubled by drugs or alcohol. We’re the experts, and we’ll do our level best to answer all your questions and get you the help you need.
According to the latest National Survey on Drug Use and Health, Rhode Islanders continue to use marijuana and illicit drugs at the highest rates in the nation.
The findings, says a news report in the Providence Journal, were no surprise to local experts who have long seen the state at the top of numerous categories of the annual survey over the years. “Nevertheless they remain somewhat mystified about the causes,” the news article said.
Another current survey by polling company Gallup found that Rhode Islanders rank second highest in the country in the use of all drugs – both illicit and legal prescriptions – just behind West Virginia and ahead of the number three state, Kentucky.
Fourteen percent of Rhode Islanders age 12 and older reported using marijuana in the past month – up from 13 percent last year, and more than any other state. This puts R.I. at twice the national average of 7.4 percent, the report said.
Rhode Island was also tops in the nation for using marijuana in the previous year: 20 percent, up from 19 percent last year.
Not surprisingly, there’s a powerful movement in the state to fast-track a legalize-marijuana bill that’s making its way through the legislature. Rhode Island already is one of 23 states and the District of Columbia that has legalized medical marijuana for licensed patients. The coalition behind full legalization, if successful, would make Rhode Island the fifth state to legalize marijuana.
Meanwhile, said the report in the Providence Journal, Rhode Islanders “also led the nation in consuming illegal drugs, excluding marijuana. About 4.3 percent reported having taken them in the month before being surveyed.”
Although the survey is “probably an accurate portrayal…we’ve seen trending for a long time, the ‘why’ is really hard to answer,” said Rebecca Boss, deputy director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
And Michael Rizzi, president and CEO of the substance-abuse treatment and prevention agency CODAC, said that regardless of why the state has such high level of drug use, relaxing marijuana laws and greater societal acceptance of the drug, should that happen, could make matters even worse.
“The issue of prevention has always been something of importance,” Rizzi said. “Marijuana, for many people, seems to be an innocuous product, and with the relaxing of the laws in Rhode Island, it makes it easier for people to make a choice, one that includes thinking ‘at least I don’t have to worry about being arrested.’”
The annual survey, conducted since 1971 by the U.S. Substance Abuse and Mental Health Services Administration, is based on interviews with randomly selected individuals. The survey doesn’t rank the states in the various categories of drug and alcohol use, but their relative standings can be deduced by examining the numbers.
State Healthcare’s Rebecca Boss said that her agency “pays attention to the survey results” and does take action as a result. For example, Rhode Island used to land at the top of the charts for underage drinking, which led to the introduction of state-wide initiatives to deal with it. As a result, the underage drinking statistics have declined.
The state is now using a federal “Partnership for Success” grant to help address public perceptions of marijuana and other drugs. “If the perceived risk goes down, the use goes up,” she said. “We are trying to be proactive and get ahead of this. We think we have programs in place that may not have an immediate impact, but will in years to come.”
Pain specialists have suspected for years that opioid painkillers are somehow related to symptoms of depression in chronic pain patients. A new study published in the medical journal Pain shows that those suspicions were indeed correct.
As chronic pain patients increase their dosage of opioid medications, says the study from Saint Louis University, they are more likely to risk the symptoms of depression or increase the symptoms of an existing depression.
But a follow-up study shows that it actually may be how long you take opioids, not how much you take, that is the real cause of increased depression. Analyses of thousands of VA patient records showed that the longer that chronic pain patients took opioids – regardless of the dosages – the greater were the chances of depression setting in or getting worse.
Jeffrey Scherrer, Ph.D., associate professor for family and community medicine at Saint Louis University, said that since the study was published in Pain, his group has conducted additional analysis of a large VA patient data base with the support of NIH funding.
The researchers wanted to see what the relationship was between duration of opioid use and the dose of opioid. Did these two factors interact? Do they have an additive effect on risk of depression?
“Our results support the conclusion that most of the risk of depression is driven by the duration of use and not the dose,” Scherrer said.
The researchers explained that the initial findings that increasing the dosage of opioids appeared to increase the risk of depression was hiding the real causes. Chronic pain patients who take opioids over long terms, Scherrer explained, tend to increase their dosages because of the buildup of tolerance. As the tolerance increases, patients require higher doses to achieve the same level of effectiveness.
“Thus, a strong potential explanation of our finding that increasing opioid dose increases risk of depression could be that the patients who increase dose were the longer using patients. This is logical as longer use is associated with tolerance and a need to increase opioids to achieve pain relief,” he said.
One of the goals of the continuing research is to discover more about the possible relationships between opioid dosages and the length of time taking them with new depression vs. stirring up past episodes of depression. Such data could help both pain management physicians and patients fine tune therapies to head off potential bouts of depression.
“We hope to find risk factors such as opioid misuse that could be in the pathway from chronic opioid use to new onset depression,” Scherrer said. “This would expand the targets for intervention to limit the risk of depression in patients who need long-term opioid therapy.”
One of the many pleasures we experience here at Novus is sharing in the lightening and brightening of patients as they shed the months or years of depressing opioid dependence. Helping patients get free from the effects of opioids is a serious activity, but we all enjoy the huge smiles at the end of those few crucial days of Novus life-changing medical opioid detox.
If you or someone you care about is in trouble with opioids – heroin, methadone or narcotic painkillers like oxycodone, hydrocodone, hydromorphone and all the others, don’t hesitate to call us here at Novus. We’ll do our expert best to answer all your questions.
It’s apparently no coincidence that the states ranking lowest for a sense of wellbeing among its citizens are also the states with the highest consumption of mood-altering drugs.
A nationwide Gallup poll, called “The State of the States” poll, has found that Kentuckians, Rhode Islanders and West Virginians consume the most mood-altering drugs, both prescription and illicit, in the nation.
And another Gallup poll has found that the least happy and satisfied people in the nation live – guess where: West Virginia and Kentucky and to a lesser extent, Rhode Island.
Anyone with an interest in drug use and abuse, drug addiction and treatment, should pay attention to these two polls. They reveal a lot about why people get caught up in drugs and alcohol. And they may help point the way to a faster, more successful recovery.
Every drug and alcohol user has his or her own reasons for consuming more than is considered healthy. But the Gallup polls suggest that each person’s story likely includes some of the common depression and lack of fulfillment that is widespread in each state.
And when more people all around you are using so many drugs and alcohol, a tacit sort of agreement about it can begin to filter into the community. The whole take-a-pill-or-smoke-a-joint-when-you’re-feeling-down thing takes on a sort of legitimacy. It breeds and spreads and becomes “the norm.”
Gallup’s “State of the States” survey polled 450 residents from each of the 50 states. It asked how often they took mood-altering drugs or medication, including prescription drugs, “to help them relax” – that is, try to make the rest of your crappy day a little better than it usually is.
West Virginians reported using such substances the most – 28 percent said they took drugs to relax almost every day. Rhode Islanders were next, at 25.9 percent, and Kentuckians were third with 24.5 percent. Alaskans reported the least drug use with only 13.5 percent.
The other Gallup poll found West Virginia and Kentucky two of the lowest-ranking states in terms of a simple sense of wellbeing.
“It’s no coincidence that drug use was inversely proportionate to the wellbeing score,” said lead researcher Dan Witters. In other words, the worse you feel about yourself and life the more drugs you reach for on a daily basis. Witters said that these feelings “increase the chances of drug use.” He pointed to such factors as obesity or even poor workplace performance contributing to a feelings of depression, a sense of low self-esteem and generalized stress – all of which can lead to drug use as compensation.
When a quarter of the population can’t – or won’t try to – get through a day without some sort of chemical assistance, there’s definitely something wrong going on. Whatever that is, these states are also among the highest in the nation for heroin and prescription opioid addictions and overdose deaths, marijuana use among teenagers, and alcoholism.
And when there’s a lot of agreement that taking drugs is an okay thing to do, you tend to see an escalation of it. And before long, it leads to dangerous drug abuse and all the tragic results that go along with that.
According to a Medical Daily report, the Gallup wellbeing survey noted that the keys to more wellbeing are found in “a variety of health, workplace and societal factors, from obesity status to the development of disease, and workplace performance to crime rates.”
Gallup defined the “five elements of wellbeing” as purpose, social, financial, community, and physical health. “States and local communities can use wellbeing concepts and the five elements as focal points in designing initiatives to improve wellbeing,” the Gallup poll said. “It’s likely that if people have a sense of wellbeing in these areas, they’d be less likely to use drugs.”
Here at Novus, we are frequently reminded of the complex personal battles being waged (and won) by our patients, and how these issues relate to the larger areas of their lives – often close to those “five elements” as seen by the Gallup pollsters.
If you or anyone you care for is using mood-altering substances to “relax and just get through the day” don’t hesitate to call us. We’ll do our best to answer your questions and see that you get the best and most appropriate help available.
The governor wants to end state funding for methadone treatment for opiate addiction and put everything into Suboxone, which has sparked heated arguments. Strangely silent are the majority who actually favor detox and abstention as standard treatment.
Nearly 4,000 Maine residents are receiving methadone treatment for opiate addiction under the state’s MaineCare (Medicaid) program. But Gov. Paul LePage wants to do away with methadone treatment entirely, and has introduced a budget that would end financial support for methadone, and switch everything to Suboxone and other drug treatments.
There are several big problems with the idea, and LePage and his cronies can’t seem to get their minds around any of them. At odds with LePage’s plan are almost everyone in the state who has a stake of any kind in opiate addiction treatment.
Addiction specialists, doctors and substance abuse specialists of all kinds are up in arms at the government’s plan, which they say ignores all scientific data. In fact, LePage’s own spokespeople admit that the governor’s plan is based entirely on finances with no regard whatsoever for science and research. The plan offers no suggestion at least for a pilot program, and apparently cares little or nothing for public opinion.
What about America’s favored treatment – abstention?
Recent national surveys show that the majority of Americans strongly believe that abstention from all drugs is the best and only way to approach opiate and other drug addictions. Most Americans don’t see any logic in switching a drug addict from one drug to another drug, often for years at a time.
Except for the rarest and most extreme cases, neither do we. Here at Novus, we’ve seen too many wonderful recoveries – countless recoveries – to buy into the drug-switching approach to treatment.
Yet the majority of Americans, people who favor safe medical drug detox followed by long-term effective rehabilitation, are not only not included in much of the ongoing debate, they’re being ignored by the state’s major news media.
This situation serves to enforce the idea that the only approach to treating opiate addiction is prescribing more drugs. Of course, nothing could be further from the truth. Every day of the week people are recovering from opiate addiction at detox and rehab centers across the country.
So what will happen if the governor gets his way?
What will happen if the plan to cut state funding for methadone clinics becomes law? A whole kettle-full of problems has surfaced during the debate:
- Suboxone is considered effective for opiate addicts with “less severe addiction.” It has clearly been shown ineffective and even dangerously so for longer-term addicts. Assigning everyone to Suboxone is absurd and actually medical malpractice.
- Suboxone is not some heaven-sent cure for anything, and it has its own problems. It is more easily diverted to addicts without a prescription than methadone. It can have deadly side effects when combined with alcohol and other medications. And the latest info from law enforcement is that it’s gaining a lot of favor in the underworld, especially in prisons, where it’s smuggled in on a regular basis.
- Suboxone costs much more than methadone, yet the governor wants to enact a law based on a perceived idea that it will cost the state less than methadone. There are a lot of figures being quoted, some saying he’s right, others that he’s way wrong.
- Suboxone must be administered by certified physicians, generally primary care doctors. Certified doctors can only treat 100 patients at a time and there aren’t nearly enough certified doctors in Maine to handle the volume now.
- The needed number of certified doctors couldn’t possibly be reached in time for the governor’s deadline. In fact, some observers say there aren’t enough doctors in the state who are willing or even interested enough in such a program to apply for Suboxone certification.
- Many of the 3,800 addicts on MaineCare currently receiving methadone at the state’s 11 clinics will be left with no available state-funded treatment. Hundreds will be faced with no other choice to stave off withdrawal except relapse – a return to the streets, to heroin and illicit opioid pharmaceuticals, to lost jobs and alienated families, to HIV and other shared needle infections and to the ultimate end – death from overdose.
Again, what about detox, rehab and abstention?
Throughout this debate, there’s been precious little input from those who believe in abstention – almost nothing in the news. It’s all about alternative drugs to treat drug problems.
There are some very powerful influences, let’s just call them “the drug lobby,” pushing for the use of drug alternatives as the only way to treat opiate addiction. Statistics supporting these drugs, and vilifying traditional detox and rehab, are highly suspect. Yet they reach all the way to federal health care levels, even the White House.
Here at Novus, we see daily evidence of the effectiveness of modern medical detoxification protocols. People are winning by abstaining from drugs, and they’re returning to their lives drug free – not shackled for who knows how many years to a methadone clinic or a doctor’s office.
If you’re in need of some help with a drug problem, call us and we’ll do our experienced best to answer your questions and get you or your loved one on the road to full recovery.
Kentucky’s state drug court program has introduced new rules to allow opioid addicts to continue taking prescribed drug treatment medications, such as methadone, Suboxone and Vivitrol, rather than making them quit such drugs as a condition of the program.
Until this past March, Kentucky insisted that to participate in drug court, addicts must taper off any treatment meds they were on within six months. The only treatment options allowed were abstention, usually in a 12-step program.
But as we reported a month or so ago, the Substance Abuse and Mental Health Services Administration (SAMHSA) ruled that federal funding for drug courts will be denied if they make offenders stop taking legally prescribed medications to treat opioid addiction.
SAMHSA was pressured into the rule change by unnamed sources (some say the White House) after a news article in Huffington Post claimed to show that abstention is not an effective treatment approach to opiate addiction. In fact this is becoming a popular refrain at high levels in spite of the fact that a majority of Americans favor traditional detox and rehabilitation according to a recent national survey, and thousands of people reclaim drug free lives every year through abstention programs.
It was a fact that most drug court judges in the country have traditionally opposed giving methadone or Suboxone to addicts as treatment – what’s called Medication Assisted Treatment or MAT by its proponents. Judges tend to view such approaches as simply replacing one drug addiction with another, with little positive changes in addicts’ attitudes, behavior or desire to seriously and permanently get clean. Not only that, MAT drugs like methadone and buprenorphine are frequently diverted for illicit use.
Unwilling to change its drug court system, Kentucky was subsequently sued by two law firms on behalf of Stephanie Watson, a Johnson County nurse with an opioid addiction. Johnson, who had been arrested on burglary and drug charges, was barred from taking medications to treat her addiction even if prescribed by her doctor.
Watson’s lawyers argued that Kentucky’s refusal to allow her to take her prescriptions violated the federal Americans with Disabilities Act. They claimed Watson’s addiction was an “illness” similar to someone with diabetes who needs insulin. The court would never disallow the insulin, they said, so why should they disallow her MAT? There was no report in the media that her lawyers also argued that their client’s criminal behavior was part of her “illness.”
Before the Watson suit was settled, the ruling from SAMHSA arrived, and Kentucky’s drug courts immediately changed the rulings about MAT. The state said that the Watson case was now “moot” because of the SAMSHA ruling. But Watson’s lawyers have not yet set it aside.
Since Kentucky’s drug court judges have long favored abstinence-only treatment, leaving it to the judge’s discretion may mean “little change on the ground,” Huffington Post reported. Although one judge is already allowing defendants to take Vivitrol, an opioid antagonist that is injected periodically to block cravings and prevent withdrawal symptoms, it’s not clear yet what the new rules will actually mean for opioid addicts entering Kentucky’s judicial system.
Kentucky is said to be “looking to expand the use of Vivitrol” and roughly two dozen drug court judges are expected to begin allowing it soon. Judges are inclined to favor Vivitrol because, unlike methadone and Suboxone, it can’t be diverted or abused and doesn’t interfere with drug tests. In the case of those drugs that are routinely diverted, Kentucky’s judges are likely to be less open to their use.
According to Huffington Post, the SAMHSA rule means judges likely will consider allowing or disallowing MAT on a case-by-case basis. And new addicts arriving in the system probably will continue being ordered to abstinence-only programs.
A lawyer for Stephanie Watson says the state’s policy change is “window dressing that won’t change how opioid addicts are actually treated.” He predicts that drug court judges will still forbid MAT and order abstinence-only programs. “Most judges are philosophically against Suboxone and methadone,” he told Huffington Post.
The lawyer added that the Watson case will go forward “because the state’s rule change doesn’t go far enough. It’s really a battle between the courts and the doctors. The doctor-patient relationship is sacrosanct. The courts should get out of the way.”
That may be a more difficult prospect than one expects. Kentucky’s judges and those in many other states have seen with their own eyes the pros and cons of treating drugs with more drugs, versus getting off drugs right now. It may seem a lot easier to a doctor to just write a prescription. But that does nothing to get at the root of addiction.
The factual success of modern medical drug detox, such as that provided here at Novus, is clearly undeniable. Abstention from the drugs or alcohol that’s been ruining one’s life is the goal, and it starts with Novus detox. Followed by long-term and effective rehabilitation, a life free from drugs is truly possible, and it starts the day you arrive at Novus.
If you or someone you care about is in trouble with drugs or alcohol, don’t hesitate to call Novus right away. We’ll answer all your questions and ensure you get started on exactly the right program to begin a life free from drugs.
Florida parents are warned: Dangerous ‘designer drugs’ are on the streets
Two synthetic “designer drugs” are killing people, or driving them to insane behavior, or both, according to reports in the media and from federal law enforcement. But instead of scaring people off because of their unpredictable and dangerous effects, the drugs are gaining in popularity among recreational drug abusers, especially teens and young adults.
The Drug Enforcement Agency (DEA), poison control centers and police forces are warning parents to be especially on the lookout for strange behavior from their kids. The effects of the newer crop of synthetic drugs are usually LSD-like, can be seriously dangerous and their side effects can last for days, perhaps longer. It’s been shown that some people can experience recurring LSD trips even years after taking the drug, and these drugs may cause the same effects.
Two notorious synthetic drugs are called “N-Bomb” and “flakka.” They’re both powerful hallucinogens that lead to extremely dangerous and violent activity. Emergency hospital admissions for synthetic drugs are rising across the country, and treatment usually involves having to manage “extreme agitation” while trying to prevent life-threatening organ damage. These drugs are, quite literally, dangerous poisons.
N-bomb has been marketed as “legal” or “natural” LSD for a few years, and it’s blamed for at least 19 deaths and possibly as many as 30, says the DEA. It was named a “Schedule 1” highly dangerous drug last November and is now illegal. N-bomb mimics the effects of LSD, but in much more erratic and unpredictable (and more dangerous) ways.
Patients admitted to emergency wards for N-bomb poisoning “require heavy sedation to calm aggression and violence as well as external cooling measures to treat hyperthermia, or overheating of the body,” according to a report in Medical Daily.
N-Bomb, is a relatively new synthetic drug from the “NBOMe” class of drugs, from whence it got its street name. NBOMes were originally developed for psychiatric drug purposes to map serotonin receptors in the brain. Today they’re one of the most frequently abused designer psychoactive substances. N-Bomb is sold as blotter paper, powder or liquid that can be ingested, snorted, or inserted rectally or vaginally, says the DEA.
Flakka is all over South Florida and is spreading like wildfire
The other drug, called flakka, is so new it hasn’t been assigned to a drug schedule. It can’t be seized as an illegal substance yet, and sellers can’t be busted for drug dealing. Flakka is made from the same type of chemicals that are used to make “bath salts,” a notoriously dangerous hallucinogenic with potentially fatal side effects.
Drug cops say flakka looks a little like crack cocaine or meth and has a unique “sweaty” odor. It is actually a form of crystal meth, usually made in overseas labs and sold over the Internet. Flakka can be swallowed, snorted, injected, smoked and easily concealed in electronic cigarettes or a vaporizer. It’s being sold on the streets of South Florida and spreading northwards. It’s in Texas and Ohio too, and cops say it’s only a matter of time before it spreads across the country.
A report in the Miami Herald, quoting from a police report last week, says a Miami man high on flakka proclaimed himself Thor, the Norse God of War, attacked a police officer and attempted to have sexual relations with a tree. The man was first seen running naked through a Brevard County community. The man was acting completely crazy and at first could not be subdued. When an officer tried to use a Taser, the guy pulled the electric probes out of his body and just punched the officer and tried to stab him with the cop’s badge. It took enormous effort to subdue the crazed victim of flakka psychosis.
Medical Daily reports that a man ran out of his Miami house last month after smoking some flakka, stripped his clothes off and screamed violently while police chased him. It took five officers to bring the man down. Police said he exhibited the same kind of super-strength that users of crystal meth often have. He was suffering from the hallucinations and paranoid delusions so often seen in people high on flakka.
CBS news reported recently that a man stoned on flakka was arrested for trying to break down a police station door, another man high on flakka was found naked and armed with a gun on a rooftop, and a third man, trying to climb a fence, slipped and impaled himself with a foot-long spike. This is a dangerous and terrible drug.
Jim Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University, describes flakka as creating a “bizarre high” which will probably “sweep the nation if it isn’t stopped.”
“We’re starting to see a rash of cases of a syndrome referred to as ‘excited delirium,’” Hall told CBS News recently. “This is where the body goes into hyperthermia, generally a temperature of 105 degrees. The individual becomes psychotic. They often rip off their clothes and run out into the street violently and have an adrenaline-like strength, and police are called and it takes four or five officers to restrain them. Then, once they are restrained, if they don’t receive immediate medical attention they can die.”
Similar effects are caused by another new drug in Florida and elsewhere called butane hash oil, also known as BHO or Budder. People put it in room vaporizers and become intensely high, with unpredictable results. Budder is the active marijuana ingredient, THC, mixed with other harmful chemicals. And police say its use is increasing.
DEA says N-bomb revenues are helping finance terrorists
N-bomb, which has already caused many deaths, may be helping finance terrorists. The DEA says it’s been acting on credible reports that revenues from synthetic drugs like N-bomb are ending up in the pockets of terrorists and criminal organizations in the Middle East. A DEA crackdown has led to 200 warrants, 120 arrests and the seizure of $20 million in cash.
“[N-bomb] is a dangerous drug, it is potentially deadly, and parents, law enforcement, first responders, and physicians need to be aware of its existence and its effects,” says Dr. Donna Seger, professor of clinical medicine and medical director of the Tennessee Poison Center. “The recreational use of synthetic (designer) psychoactive substances with stimulant, euphoric, and/or hallucinogenic properties has risen dramatically in recent years.”
Seger adds that the quality control of these street drugs is nonexistent. Misjudging a dose could lead to significant toxicity, with such symptoms as hypertension, rapid or irregular heartbeat, hyperthermia, dilated pupils, agitation, aggressive behavior, delirium, hallucinations, seizures, and even renal failure or coma.
Here at Novus, we help patients overcome dependence and addiction to alcohol and drugs of all kinds. We don’t see people on synthetic designer drugs as a rule, but their capacity to create dependence and addiction has already begun to surface here and there across the country.
If you or someone you know has been experimenting with synthetic drugs like N-bomb or flakka, we strongly urge you to confront this problem right away. These are very dangerous drugs because their side effects are extremely unpredictable and are potentially lethal.
Categories: Drug Facts
A troubled Marine who overdosed and died in a VA psych ward is only one of many cases of overdose in recent years. But the VA assured the committee in March that the rampant opioid prescribing has begun to ease off and other measures are being taken.
The Veteran’s Affairs has come under the gun after a damning report by the Center for Investigative Reporting on opioid prescribing at a VA hospital in Wisconsin found a 14-fold increase in oxycodone pills prescribed.
The Center found opioid painkillers prescribed at the Tomah VA Medical Center soared from 50,000 hydrocodone pills in 2004 to 712,000 pills in 2012. There was apparently no significant increase in the number of patients – just in the number of oxycodone pills prescribed per patient.
Veterans also told a reporter that opioid use was so rampant at the hospital that the soldiers gave the place the nickname “Candy Land.”
When a 35-year-old Marine Corps veteran died of an opioid overdose while in the hospital’s psych ward last August, it was only the latest in a long string of heartbreaks for veteran’s families going back many years.
Numerous reports from the VA Inspector General (IG) over the past five years say veterans are dying from medication overdoses across the country. Whistleblowers have also alerted the IG several times about dangerous opioid and benzodiazapine prescribing practices – a particularly deadly cocktail.
Tests not being done, leaving patients at risk
Yet in spite of the deaths, whistleblower warnings and the IG’s official reports, routine drug tests to monitor narcotics uses and abuses are still not being performed in the nation’s VA hospitals or among the many thousands of outpatients receiving medications.
And according to the reports, doctors are even prescribing medications to patients they have not even seen in person. Although this is a violation of written VA policy, one would think it’s a violation of basic ethical medical practice anywhere.
And just a couple of weeks ago, a former pharmacist at the Tomah VA told the committee she was “discouraged by higher-ups” from performing drug tests, in contravention of VA guidelines.
Noelle Johnson, who was fired from that facility and now is employed as a VA pain management specialist in Des Moines, said pharmacists at Tomah were discouraged from testing patients for drug use for fear of what “prescribing physicians might learn.”
Johnson said she was told that if the tests were negative, it could indicate the patient wasn’t taking their meds and were instead maybe selling them. And if the tests were strongly positive, it could “suggest overuse or abuse” and the VA could be held liable “when something unfortunate happened.”
“I believe that this is the point of urine drug testing, to substantiate use and misuse of high-risk medications for the safety of veterans and the public,” Johnson told the committee. “What happened to the doctors’ oath of ‘First Do No Harm?’”
VA is taking steps, says spokesperson
Dr. Carolyn Clancy, the VA’s interim Under Secretary for Health, told the committee that the VA has gotten the message and is taking steps to remedy the situation. Clancy said that the best way to curtail prescription drug abuse and overdose is to avoid prescribing addictive medications like fentanyl, hydrocodone or oxycodone. She said that several VA programs are in place and already working to reduce the number of prescriptions and subsequent “accidental deaths.”
“Chronic pain management is challenging for veterans and clinicians,” Clancy told the Committee. “Opioids are an effective treatment but their use requires constant vigilance to minimize risk and adverse effects.”
Clancy said a program to educate physicians on the VA’s narcotics prescription guidelines was introduced in three areas in 2013 and has been adopted by about a third of the VA’s health regions. It’s already bringing about reductions in the number of prescriptions, and also beefing up appropriate testing and tracking of patients, she said, and the VA will expand the program to include all its medical centers.
Another program, Clancy said, is called the Opioid Safety Initiative, also started in 2013, and is also helping reduce the numbers of opiate prescriptions. Since 2012, the number of patients receiving opioids has declined by 13 percent, she said, and those using opioids and benzodiazepines together — a cocktail that can have fatal consequences if taken incorrectly — has dropped by 24 percent.
Clancy also told the Veteran’s Affairs Committee about VA’s Overdose Education and Naloxone Distribution program (OEND) which provides emergency kits containing the opioid overdose antidote drug naloxone to veterans on high doses of opiates or who use multiple medications to manage pain.
Naloxone program saving lives
Since its introduction last May, she said, more than 2,400 kits have been provided to such veterans, their families or friends. And at least 41 veterans have been rescued from overdoses since the OEND program began.
Naloxone instantly reverses the respiratory depression that kills the victims of opioid overdose. It’s administered by nasal spray or injection, and is easy enough for anyone with a few minutes of instruction to use. It’s normally carried in ambulances, is used at all ERs, and is carried by many police forces across the country, since cops are very often on the scene of overdoses even before the EMT people.
The overuse of opiates for pain management and the resulting widespread dependencies, abuses and addictions to these highly addictive medications is not just a VA problem. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently called the overprescribing of opioids “a national epidemic.”
Frieden said the prescribing practices of America’s physicians is the primary source of the epidemic. But the VA’s physicians went to all the same med schools as the rest of America’s doctors. So we shouldn’t expect anything different at the VA.
The Institute of Medicine says a hundred million Americans are suffering from chronic pain on any given day. Yet medical schools devote less than two days – maybe 8 to 10 hours tops – to the treatment and management of pain, including chronic pain. There are only a few thousand actual certified pain specialists in the entire country – just a drop in the bucket.
Senator says he’s “angered and disgusted”
Ranking committee member Sen. Richard Blumenthal (D-CT) said he is “angered and disgusted” that so little appears to have been accomplished to address overprescribing since the committee’s last session on the same topic.
“I want this hearing to be different, to produce action,” Blumenthal said. “This epidemic has been with us for years and years and that’s one reason for my anger and astonishment that the VA system isn’t better than it is.”
Here at Novus, we’re also looking forward to a time when opioid prescribing in and out of the military is under control. Meanwhile we’re here 24/7 helping people who have fallen victim to prescription opioids. If you or someone you care about is suffering from the addictive effects of prescription pain meds, don’t hesitate to give us a call. We’re always here to help.
The number of babies born in Florida dependent on opioids like heroin and hydrocodone has increased more than 10-fold since 1995, says a new report from the Centers for Disease Control and Prevention (CDC). And the soaring 10-fold increase “far exceeds the three-fold increase observed nationally,” the report said.
The CDC added that only 10 percent of the mothers who used opioids during pregnancy received, or were even referred for, treatment for drug dependencies.
Babies exposed to addictive prescription or illicit drugs taken by a mother during pregnancy can suffer a wide range of physiologic and neurobehavioral side effects. The condition, called Neonatal Abstinence Syndrome (NAS), is terribly sickening and painful for newborns, and can be life threatening if not treated correctly.
CDC was helping Florida streamline patient information system
In February 2014, the Florida Department of Health asked the CDC to help assess the accuracy and validity of the state’s hospital inpatient discharge data linked to birth and infant death certificates. The state wanted to know if the information could correctly monitor NAS in the state, and if it accurately describes the characteristics of infants with NAS and their mothers.
This new CDC report only focuses on the second objective – describing maternal and infant characteristics.
The CDC studied the data for 242 confirmed cases of NAS during a 2-year period (2010–2011) identified in just three Florida hospitals. The conclusions were extrapolated to apply to the whole state.
97 percent of NAS babies had to be admitted to ICU
“Infants with NAS experienced serious medical complications with 97.1 percent being admitted to an intensive care unit,” the report states, “and had prolonged hospital stays for a mean duration of 26.1 days.”
In other words, many, if not most of those 242 newborns spent nearly a month in the hospital being weaned off the addictive drugs. And the story would be the same at any of the rest of the state’s several hundred hospitals. The cost of such treatment can reach six figures for each infant.
“The findings of this investigation underscore the important public health problem of NAS,” the CDC said, “and add to current knowledge on the characteristics of these mothers and infants.”
Partly as a result of the CDC study, as of June 2014, NAS became a mandatory reportable condition in Florida – that is, diagnosed cases must by law be reported to the Florida Department of Health.
Mothers involved in cases of NAS need intervention
As to the lack of care offered or provided to drug-using mothers, the CDC says intervention should be increased, not just for NAS mothers but for all women of child-bearing age. Such intervention is needed to:
- Increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age
- Improve drug addiction counseling and rehabilitation referral and documentation policies, and
- Link women to these resources before or earlier in pregnancy.
Only 1 percent of mothers used heroin, 99 percent prescription drugs
Once again, more evidence of America’s appalling abuse of prescription drugs: Over 99 percent of drug-exposed mothers were using prescription drugs, not street drugs like heroin.
While the whole country is up in arms about “the heroin epidemic,” less than 1 percent of NAS mothers had used heroin during pregnancy. Here’s the whole drug-use-while-pregnant picture:
- Less than 1 percent of mothers were reported to have used heroin during pregnancy
- Approximately 82 percent of mothers were using one or more prescription opioids, such as oxycodone, morphine, hydrocodone, hydromorphone, tramadol or meperidine
- 59.9 percent were using methadone and 3.7 percent using buprenorphine – both drugs commonly used for treatment of opioid dependence
- 40.5 percent were using benzodiazepines such as Xanax, Klonopin, Lorazepam / Ativan and Valium (diazepam)
- After benzos came tobacco at 39.7 percent, marijuana at 24.4 percent and cocaine at 14.1percent
- Reasons reported for opioid use included illicit (nonmedical) at 55 percent, drug abuse treatment at 41.3 percent and chronic pain treatment at 21.5 percent
- The reason for opioid use during pregnancy was unknown for 10.3 percent of NAS mothers
- Only 10.3 percent of mothers apparently received or were referred for drug addiction rehabilitation or counseling during the infant’s birth hospitalization.
Over 99 percent of NAS was from opioids
- Nearly all infants with NAS – 99.6 percent – were exposed to opioids in utero, which definitely highlights the widespread issue of opioid use in women of childbearing age.
- Women face many barriers in accessing any type of substance abuse treatment, which might also be reflected in the finding that only 10.3 percent of mothers of infants with NAS received or were referred for drug addiction rehabilitation or counseling during their infant’s birth hospitalization, despite a high percentage of mothers with positive urine toxicology screen results.
- Because abstinent detoxification during pregnancy is dangerous to the fetus, medication assistance is recommended as the standard of care for pregnant women with opioid addiction.
- Comprehensive medication assistance coupled with correct prenatal care reduces the usual complications associated with untreated opioid use disorder.
Bottom line, even one baby born dependent on drugs is one too many. Here at Novus, we deeply care about the situation, and take care to help all our female patients of child-bearing age understand the vital need for all pregnancies to be drug-free of any addictive or other toxic substances.
If you know a woman of child-bearing age who is dependent on opioids, please help them to come off these drugs before pregnancy occurs. Have them call Novus, or contact us yourself and we will help.